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I agree with trying the lower pressures. The straight 6 setting is going to give us a pretty good base line from which to suggest adjustments if any. One question I have is about your original diagnosis, any sleep studies and results of a titration. In other words, how did your Sleep Doc come up with your original settings and why did you go in the first place? Good luck tonight.

Going back to what we discussed previously, what you are demonstrating here is a tolerance for split pressure IPAP/EPAP. Your events are still predominately hypopnea. So we can build on this if we can get you approved for bilevel, by maintaining the minimum EPAP to relieve OA and your aerophagia, then use pressure support to suppress hypopnea. Also, you could benefit a lot from true bilevel. The Dreamstation implementation of EPAP pressure relief is very different and terrible for you aerophagia. When your flow rate goes to zero, the Dreamstation Flex returns pressure to IPAP which basically injects air into your stomach. Using true bilevel, the pressure will follow your breathing, initiating EPAP when you exhale, and holding that low pressure until you inhale. In your case, the Resmed implementation is going to be much better than Respironics. There is a lot of technical reasons why. Talk to your doctor about getting this done.

Thanks for the feedback. Yes, I'll give 7/7 a shot. I've spoken with my provider, who is on board, but the doctor is hung up on my previous titration being a 10 cpap. It may take me a while to get back in to see him but I will bring my laptop and sleepyhead data if/when I do.

I'm hoping he will just call in the change since he already knows how much I've been trying to find something that will work.

My provider is on my side, but mainly works with Dreamstations so she said they would have to order anything resmed. Sounds like the Aircurve V10 Auto is the one I should ask for?

Hopefully in the meanwhile some more experimenting will get me at least a little bit of help.

I would go for the Aircurve 10 Auto. I have a PRS1 60 Series BiPAP Auto and the Aircurve, and both work well for me. I do notice stronger pressure changes and occasional poor sync on the PRS1 more than the Resmed.

While your doctor is getting hung up on a CPAP titration of 10, he needs to understand that it was merely the best titration result of a CPAP study that did not even look at bilevel. Also, it had no capability to evaluate the longer term impact of constant pressure on your aerophagia. We already outlined the whole intolerance of CPAP thing, so I won't repeat it. We are trying to put a bandaid on this with a CPAP and it's not the right tool for the job.

(10-19-2016, 09:55 AM)Ezil71 Wrote: My provider is on my side, but mainly works with Dreamstations so she said they would have to order anything resmed. Sounds like the Aircurve V10 Auto is the one I should ask for?

I'll chime in a note of support for the PR Dreamstation BiPAP Auto over the Resmed V10 Auto.

The PR BiPAP algorithm is different from the Resmed V10 Auto one, but if aerophagia is an issue (as it seems to be) there's one difference between the PR Dreamstation BiPAP Auto algorithm and the Resmed V10 Auto algorithm that may make the Dreamstation a better match:

The Resmed V10 Auto will increase both the EPAP and the IPAP in response to any kind of events. The PR BiPAP Auto algorithm, however increases the EPAP and IPAP independently of each other. The only things that increase the EPAP are clusters of obstructive apneas and snoring. Flow limitations, RERAs, and clusters of hypopneas without any OAs only increase the IPAP. What this means is that with a PR BiPAP you may find that the average, median, and 90/95% EPAP pressures are lower than what you get with a Resmed V10 Auto. If the aerophagia is caused by more EPAP than your digestive system can tolerate, the PR Dreamstation BiPAP Auto may be the better choice.

I will also add this: If you do go with the PR Dreamstation, you may want to make sure that BiFlex is turned OFF. BiFlex works sort of like regular Flex on the DreamStation APAP/CPAPs---at the start of each exhalation it adds an additional bit of extra exhalation relief beyond that provided by the drop from IPAP to EPAP, but there is a pressure increase up to the EPAP setting during the second half of the exhalation. I find that I am much more comfortable in terms of aerophagia when I have BiFlex turned completely OFF.

I will add: I am a PR Dreamstation BiPAP Auto user. I was switched from a Resmed S9 AutoSet to a PR System One BiPAP Auto about 4 months after I started CPAPing about 6 years ago. My big issue was aerophagia even at very low pressures. So my answers are built on my own experiences. In my case, keeping my EPAP as low as possible is critical for keeping my aerophagia under control.

(10-17-2016, 10:44 AM)Sleeprider Wrote: I have both the Philips Respironics Auto BiPAP and Resmed Aircurve 10 Auto. I think the Resmed follows your breathing more and keeps the EPAP pressure low until you spontaneously initiate the next breath. I want to emphasize that there are no guarantees, but you do meet the insurance criteria for intolerance of CPAP and authorization for bilevel. The intention of my comment is to help you lay that out with your doctor, and hopefully find something that works better. I wish Robysue was more active on this forum as she has similar issues, and also went to bilevel. Another member, JVinNE had very bad aerophagia along with central apnea, and used a bilevel ASV which worked.

I haven't been very active in the last few months because real life has had a bad habit of interfering with my desire to spend my time on forums. However, I hope that things are finally starting to settle down in my personal life and that I can start contributing again.

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